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Emergency Medical Services (EMS) protocol implementation can be a challenging endeavor given the large and diverse provider workforce. These efforts can be even more challenging given training restrictions, career and volunteer combination EMS agencies, and inconsistent work schedules. In an effort to educate as many providers as possible in a relatively short time, the community of practice educational model was used during a new evidence-based EMS protocol implementation. This model identifies providers who are enthusiastic during initial training as advocates. These advocates then continue to educate their peers going forward. This allows for the initial educational effort to continue to propagate during pilot testing and beyond. During this protocol implementation, a total of 17 educational visits were made to EMS stations and 43 providers were identified as advocates.

In general, the first decision to be made in a patient with a confirmed head and neck cancer is whether or not to treat the patient before deciding what form of management strategy is appropriate. There is no more important an aspect of head and neck cancer care than the initial evaluation of the patient and the patient's tumour. The practice requires specific expertise and judgement. The current tumour–node–metastasis system relies on morphology of the tumour (anatomical site and extent of disease) but the final decision on treatment hinges on a full assessment of the patient including physiological age and general condition. The aim of this paper is primarily to describe why and how we appraise a patient and their tumour. It addresses the general principles applicable to the topic of evaluation, classification and staging. In addition, the limitations and pitfalls of this process are described.

Recommendations

• All patients with head and neck cancer (HNC) should undergo tumour classification and staging prior to treatment. (R)

Guided by a review of the anatomical literature, 36 sulci on the
human cerebral cortical surface were
designated as homologous. These sulci were assessed for visibility on 3-dimensional
images reconstructed
from magnetic resonance imaging scans of the brains of 20 normal volunteers
by 2 independent observers.
Those sulci that were found to be reproducibly identifiable were used to
define 24 landmarks around the
cortical surface. The interobserver and intraobserver variabilities of
measurement of the 24 landmarks were
calculated. These reliably reproducible landmarks can be used for detailed
morphometric analysis, and may
prove helpful in the analysis of suspected cerebral cortical structured
abnormalities in patients with such
conditions as epilepsy.

We discuss a model for the origin of cetacean swimming that is based on hydrodynamic and kinematic data of modern mammalian swimmers. The model suggests that modern otters (Mustelidae: Lutrinae) display several of the locomotor modes that early cetaceans used at different stages in the transition from land to water. We use mustelids and other amphibious mammals to analyze the morphology of the Eocene cetacean Ambulocetus natans, and we conclude that Ambulocetus may have locomoted by a combination of pelvic paddling and dorsoventral undulations of the tail, and that its locomotor mode in water resembled that of the modern otter Lutra most closely. We also suggest that cetacean locomotion may have resembled that of the freshwater otter Pteronura at a stage beyond Ambulocetus.

Recently developed nanocrystalline magnetic systems are of considerable interest fundamentally as well as technologically. One such material is Fe73.5B9Si13.5Cu1Nb3, which can be produced by heat treating the amorphous precursor. This forms a noncrystalline phase with typical dimension of 350 A as determined by neutron diffraction. Small angle neutron scattering (SANS) has been employed to investigate the properties of the nanocrystallized material over the temperature range from 10 K to 725 K, a regime where no significant structural changes are expected to occur. In zero field and low temperature (10K) we obtained an isotropic scattering pattern. The application of a relatively modest field to sweep out the domains changed the scattering to a "butterfly wings" pattern typical of patterns dominated by magnetic elastic intensity. Up to 450 K this pattern changed only modestly, while for substantially higher temperatures the ratio of inelastic to elastic scattering increased rapidly as the magnetic phase transition of the intergranular component (≃ 575 K) was approached. Triple axis inelastic measurements showed that the majority of the magnetic inelastic scattering was from the nanocrystalline phase.

The genus Bathyporeia has featured in many reports on the ecology of sandy beaches, yet little is known of the annual reproductive cycles of the species in British waters. Watkin (1938,1939a, b, 1941, 1942) has studied the taxonomy and aspects of the ecology of the genus, and more recently Salvat (1967) has described the annual reproductive cycle of B. pilosa Lindstrom, B. pelagica (Bate), B. sarsi Watkin and B. guilliamsonia (Bate) on the west coast of France. The present report is the result of an investigation into the vertical distribution and annual reproductive patterns of B. pilosa and B. pelagica on a sandy beach at Ynyslas, Cardiganshire. Whilst enabling comparisons to be made with Salvat's data, this study also forms the basis for an investigation into the ecophysiological complex of B. pilosa and B. pelagica.

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